Surgery for diverticular peritonitis

TL;DR

This paper reviews surgical options for treating severe diverticulitis with peritonitis, focusing on less invasive alternatives to traditional procedures.

Contribution

The paper highlights laparoscopic peritoneal lavage as a viable alternative to laparotomy for Hinchey III peritonitis.

Findings

Laparoscopic Peritoneal Lavage is an effective alternative to laparotomy for Hinchey III peritonitis.

Hartmann’s operation does not improve survival and often results in a permanent stoma.

Primary anastomosis is supported by recent evidence unless the patient is critically ill.

Abstract

Some patients with acute diverticulitis will present with colonic perforation and peritonitis. This paper is a review of the surgical management of diverticular peritonitis Hinchey III and Hinchey IV. The significance of prompt management of sepsis is discussed. The surgical options for Hinchey III and Hinchey IV peritonitis are discussed with presentation of the supporting literature. In Hinchey III peritonitis Laparoscopic Peritoneal Lavage has emerged as an alternative to laparotomy—colectomy. The classic Hartmann’s operation has no advantage of survival and results frequently in permanent stoma. Recent published evidence supports on table colonic lavage and the performance of primary anastomosis unless the patient is critically ill.